title: Impact of perioperative renal dysfunction in heart transplantation: combined heart and kidney transplantation could help to reduce postoperative mortality.
abstract: BACKGROUND
  Renal dysfunction is a frequent problem in heart failure patients. We aimed to investigate the predictors of mortality after heart transplantation and the impact of perioperative renal dysfunction on short-term and long-term prognosis.
  
  
  METHODS
  We analyzed the outcomes of patients undergoing isolated heart transplantation (IHT, n=62) and combined heart-kidney transplantation (CHKT, n=5) between October 2007 and May 2012. Among all patients, 55.2% had preoperative renal dysfunction.
  
  
  RESULTS
  Compared with the IHT group, the CHKT group had a lower estimated glomerular filtration rate (p=0.001), and higher proportion of diabetes (p=0.008), hypertension (p=0.010), renal failure (p=0.036), and greater incidence of preoperative continuous renal replacement therapy (CRRT) (p=0.025). Despite unfavorable baseline conditions in the CHKT group, there was no postoperative mortality. Early 30-day postoperative mortality only occurred in the IHT group (5 patients, 8.1%). In multivariate analysis, persistent renal dysfunction (HR 29.356, p<0.001), donor heart ischemic time (HR 1.014, p=0.005), and duration of mechanical ventilation (HR 1.012, p=0.026) were significant predictors of overall mortality. The patients with persistent renal dysfunction at 1 month after transplantation showed significantly lower survival rates compared to the patients with complete renal recovery (10% vs. 93% at 1 year, p<0.001). In the long-term follow-up of patients who had preoperative renal dysfunction, IHT showed only 64% survival, whereas CHKT showed 100%.
  
  
  CONCLUSIONS
  Renal dysfunction was a common manifestation in heart transplantation recipients. Persistent renal dysfunction after transplantation was the most powerful independent predictor of overall mortality. CHKT could help to reduce postoperative mortality in end-stage heart failure patients with renal dysfunction.
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Joo Myung
authors.initials: JM
authors.lastname: Lee
authors.forename: Seung-Ah
authors.initials: SA
authors.lastname: Lee
authors.forename: Hyun-Jai
authors.initials: HJ
authors.lastname: Cho
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Hwang
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Min
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.forename: Jae Seok
authors.initials: JS
authors.lastname: Yang
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.forename: Young-Bae
authors.initials: YB
authors.lastname: Park
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome